MEDICARE: THE DAVID VICKERY LIMITED PARTNERSHIP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	P1021	TN

General Provider Information

NPI Number	:	1427270834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DAVID VICKERY LIMITED PARTNERSHIP

Provider Business Mailing Address
First Line	:	3363 HIGHWAY 45 NORTH
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305
Country	:	US
Telephone Number	:	731-664-8444
Fax Number	:

Provider Business Practice Location Address
First Line	:	3363 HIGHWAY 45 NORTH
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38305
Country	:	US
Telephone Number	:	731-664-8444
Fax Number	:

Authorized Official
Title or Position	:	GENERAL PARTNER
Name	:	DR. JOHN DAVID VICKERY
Credential	:	PH.D.
Telephone Number	:	731-664-8444

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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